Improved results with conventional management of infrarenal aortic infection

Purpose: Interest in alternative methods, such as autogenous vein grafts an d aortic allografts, for the management of infrarenal aortic infection (IRA I) has been stimulated by the historically disappointing results with conve ntional surgical management. Recently, there have been dramatic improvement s in the results of axillofemoral bypass grafting (AXFB) followed by excisi on of the IRAI that have gone relatively unrecognized. The purpose of this report is the presentation of modern-day results in the treatment of IRAI w ith conventional surgical methods. Methods: From January 1, 1983, through June 30, 1998, patients with IRAI un derwent treatment with AXFB and complete excision of the IRAI. The patients were followed for survival, Limb salvage, and AXFB graft patency. The resu lts were tabulated with life-table methods. Results: During the 15-year study period, 60 patients (51 men, nine women; mean age, 68 years) underwent treatment for IRAI (50 graft infections, incl uding 16 graft-enteric fistulae, and 10 primary aortic infections). The mea n follow-up period was 41 months. The perioperative mortality rate was 13% (12% for graft infection, and 20% for primary infection). The overall 2-yea r and 5-year survival rates were 67% and 47%, respectively. The limb salvag e rates at 2 and 5 years were 93% and 82%, respectively. The 5-year primary AXFB graft patency rate was 73%. Conclusion: These results show an improvement with the conventional managem ent of IRAI equal or superior to those results reported with alternative me thods, including femoral vein grafts or aortic allografts. These results sh ould be regarded as the modern standard with which alternative therapies ca n be compared.